Heart valve disease is a common cardiac condition, and heart valve treatment without surgery was once unimaginable. Today, medical advances have introduced non-surgical techniques that offer safer, more comfortable options for patients. In this article, we will explore the leading heart valve treatment methods without surgery, the cases they suit best, and their success rates.
What do heart valves do?
The heart is made up of four main valves: The mitral valve, the aortic valve, the tricuspid valve, and the pulmonary valve. These valves act as one-way doors, regulating the flow of blood between the cardiac chambers and the large vessels, preventing it from flowing backward.
Oxygen-poor blood starts in the right atrium, then passes through the tricuspid valve into the right ventricle, which in turn pumps it through the pulmonary valve into the lungs for oxygenation. The oxygen-rich blood then returns to the left atrium, crosses the mitral valve into the left ventricle, and finally rushes through the aortic valve into the aorta and then throughout the body.
When valves function normally, the heart ensures that blood flows efficiently in a specific pathway. But if something goes wrong, such as stenosis (narrowing of the valve opening) or regurgitation (blood leaks backward because the valve doesn’t close tightly), the heart has to work extra hard to pump blood, which over time can lead to serious complications such as heart failure.
When do heart valves need treatment?
Heart valves can malfunction as a result of aging, birth defects, infections, or chronic diseases such as diabetes and heart disease. When valves don’t function properly, the heart has to work harder to pump blood, leading to symptoms such as shortness of breath, palpitations, fatigue, or swollen legs.
The most common valve issues are:
- Regurgitation: Blood leaks backward because the valve does not close tightly.
- Stenosis: Narrowing of the valve opening due to stiffening of the cusps.
- Atresia: The valve is absent or does not form normally.
The doctor diagnoses the condition through a clinical examination and hearing the heart murmurs, as well as advanced tests such as echocardiography, ECG, MRI, or cardiac catheterization. These tests help determine the severity of the disease and the timing of treatment.
What are the options for heart valve treatment without surgery?
With medical advances, heart valve treatment without surgery can be performed using catheter-based, minimally invasive techniques, minimizing the need to open the chest and contributing to a faster recovery and reduced risks, especially for elderly or high-risk surgical patients.
Transcatheter Aortic Valve Replacement (TAVR/TAVI)
Known as TAVR or TAVI, this procedure is used to treat aortic valve stenosis that prevents the heart from pumping blood normally to the body. An artificial valve is inserted through a catheter into the femoral artery or chest, and the catheter is guided using X-rays or other imaging techniques. The doctor expands the new valve using a balloon or self-expanding valve, and the catheter is removed after the valve is in place.
This is a non-invasive procedure that involves a smaller incision compared to open surgery. As a result, patients experience a faster recovery and a shorter hospital stay. It helps alleviate symptoms such as shortness of breath and chest pain associated with aortic valve stenosis. This procedure is often recommended for older adults or individuals at high risk for open-heart surgery.
Transcatheter Mitral Valve Repair (MitraClip)
In the case of Mitral valve regurgitation, MitraClip can be used to close the leak without the need for open surgery. The procedure begins with a tiny catheter inserted through a vein in the groin and guided through a small hole in the atrial septum into the left atrium. Once the catheter is in place, the forceps are placed between the cusps of the mitral valve to precisely close the leak, with continuous X-ray and ultrasound to monitor their position and ensure the best possible outcome. The forceps are then permanently left in place to maintain normal valve function.
The forceps help reduce blood leakage into the left atrium and lungs, relieving shortness of breath and fluid retention and improving the patient’s ability to perform daily activities. The procedure is safe and effective for patients who cannot undergo conventional valve replacement surgery, allowing them to receive advanced valve treatment without the risks of lengthy open surgery and difficult recovery.
Balloon valvuloplasty
Balloon valvuloplasty is a simple procedure used to treat narrowing of any heart valve, most commonly the mitral or aortic valve. The doctor inserts a catheter containing a deflated balloon through a blood vessel in the groin or arm, guides it to the narrowed valve, inflates the balloon to widen the valve, and then removes it. This procedure increases blood flow and reduces heart effort and may be used as a temporary solution or to postpone the need for valve replacement, with advantages such as faster recovery, less pain, and lower risks than open surgery.
Advantages of heart valve treatment without surgery
Heart valve treatment without surgery offers many advantages over conventional surgery, including:
- Less damage and pain: Smaller incisions minimize tissue damage, making recovery quicker and more comfortable, with less need for pain medication.
- Faster recovery and shorter hospital stays: Patients can often leave the hospital in a few days rather than a week or more, allowing a quicker return to daily activities.
- Lower risk of complications: Minimally invasive surgery reduces the risk of infection, blood loss, or any complications associated with open surgery.
- Improved cosmetic results: Smaller incisions leave fewer scars, which is especially important for younger patients or those who are concerned about post-operative appearance.
Is heart valve treatment without surgery suitable for everyone?
Despite its many advantages, heart valve treatment without surgery, including catheter-based valve replacement, is not suitable for every patient. The decision depends on several factors, including the type of valve affected, the severity of stenosis or regurgitation, the patient’s overall health, the presence of chronic conditions, and the cardiologist’s and heart team’s evaluation, which determines whether catheterization or open surgery is more appropriate.
Some patients may still require conventional surgery if their condition does not permit minimally invasive procedures, while heart valve treatment without surgery remains a safe and effective choice for older adults and those who are not candidates for open-heart surgery.
These modern techniques provide a reliable alternative for patients who are not able to undergo conventional surgical procedures. It is crucial to consult a cardiologist to determine the most appropriate approach for each patient’s unique health status. Today’s non-surgical methods can effectively replace major operations and minimize the risks associated with open-heart surgery.
Sources:
- Columbia University Department of Surgery. (n.d.). Repairing heart valves without surgery.
- American Heart Association. (2024, June 6). Less invasive heart valve surgery options.
